Pediatric and Adolescent Mental Health

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Pediatric and Adolescent Mental Health

• John Sargent, M.D.

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Goals of Child Rearing

• Optimal development
• Effective emotional, cognitive and behavioral
  functioning

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• Capacity for meaningful occupational
  participation
• Satisfying relationships and family life
• Rewarding recreational experiences
• Successful adaptation to and participation in
  ones neighborhood and community

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Recognizing Intrinsic Differences

• Physical Status
• Intellectual capacity
• Temperament
• Culture and ethnicity

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• Family relationships
• Socio economic status/access to resources
• Capacity for modulation of emotions
• Capacity to manage and direct behavior

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Unique Characteristics of Child Mental Health
Problems

• Often represent gene-environmental interactions
• Symptoms of the disorder often worsen the
  disorder
• Impact development and overall skill acquisition

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• Affect and are affected by family relationships
  and family behavior
• Early recognition and early effective treatment
  significantly reduce mortality and morbidity
• Sources of resilience and risk strongly influence
  the occurrence and course of child and adolescent
  mental health problems

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Sources of Resilience

• High intelligence
• Even temperament
• Physical attractiveness
• Special skills and abilities
• Commitment of caretaker to childs well
  being and development
• Strong social support for family and caretaker

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Sources of Risk

• Poverty
• Recent move or immigration
• Marked marital or post separation conflict

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• Family violence, abuse or neglect
• Community disruption
• Poor resource availability

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Types of Child and Adolescent Mental Health
Problems

• Disorders of Social Interaction
• Autism
• Aspergers Syndrome
• Internalizing Disorders
• Anxiety Disorders
• Depression
• Trauma Responses
• Externalizing Disorders
• Attention Deficit Hyperactivity Disorder
• Conduct Disorder

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• Appetite Disorders
• Eating Disorder
• Substance Abuse
• Self-Harming Behavior
• Mental Retardation
• Learning Disability
• Early onset major mental illness
• Schizophrenia
• Bipolar Disorder

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Mental Health Treatment Options for Children and
Adolescents

• Individual Psychotherapy
• Family education and psychotherapy
• Psychopharmacology

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• Special education programs
• Treatment programs
• Inpatient residential
• Day treatment
• Legal responses
• Detention
• Group homes
• Probation

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• Community treatment
• Home based therapy
• Therapeutic foster care
• Mentoring programs
• Crisis intervention
• Mobile crisis unit
• Police with special training

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Goals of Treatment

• To enhance the childs adaptation to his
  environment
• To support the communitys efforts to accommodate
  to the childs unique differences

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Specific Child Psychiatric Syndromes and Treatment

• Autism and Aspergers
• Spectrum of poor socializing ability
• Generally require educational/behavioral program
• May require medication for anxiety,
  aggressiveness or hyperactivity
• Prognosis depends on language development and
  intellectual capacity

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Attention Deficit Hyperactivity Disorder

• 3 6 of population
• Onset before age 7
• Problems with concentration, activity level and
  organization
• Concerns at home, school and with peers
• Treatment includes
• Stimulants
• Educational support
• Parental supervision
• Consistency

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Depression

• 3 of children
• 5 8 of adolescents
• Risk for suicidal behavior
• School failure
• Poor relationship and occupational outcome
• Treatment combination of psychotherapy
  and SSRI medication
• Major issue
• Early identification
• Appropriate treatment

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Anxiety Disorders

• 5 of children
• Excessive worry interfering with function
• Obsessive Compulsive Disorder most common
• Worry is alleviated by rigid and time consuming
  compulsions, counting, washing and checking
• Social anxiety is frequently troubling during
  adolescence interfering with social relationships
  and selfesteem
• Treatment can be very effective

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Post Traumatic Stress Disorder

• Significant trauma through abuse, neglect,
  illness, accident or other traumatic expericene
• Symptoms include arousal changes, avoidance and
  reexperencing
• Can be persistent and seriously disabling

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• Often complicated by depression, substance abuse
  and risk taking behavior
• Psychotherapy highly effective, especially if
  initiated early

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Eating Disorders

• 1 3 of adolescent and young adult women
• Bulimia (recurrent binge eating and purging) can
  be chronic and relapsing

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• Anorexia has 5 10 mortality rate and can
  be chronic
• Early treatment most effective
• Requires multidisciplinary treatment approach

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Conduct Disorder

• More common in boys
• Cruelty to animals often an early symptom
• Can persist and develop into antisocial
  personality and lifelong criminality

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• Linked to poor parental supervision and family
  violence
• Often associated with substance abuse
• Positive relationship with school and with
  prosocial peers are good prognostic signs

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• Placement away from home and with similar youth
  does not improve the problem
• Home based, intensive family treatment leads to
  75 recovery rate

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Substance Abuse

• Has declined in youth in the past 15 years
• Frequently associated with other psychiatric
  disorders and complicates their treatment
• Use of several drugs is common

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• Drug abuse is associated with poor family
  relationships and poor parental supervision
• Treatment is based on improving family
  relationships and building the childs skills and
  abilities

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Bipolar Disorder

• Can occur in childhood and adolescence
• Mood fluctuations are associated with marked
  irritability, temper outbursts and impulsivity
• Can be difficult to treat and is often chronic
• Frequently occurs in families with other member
  swith Bipolar Disorder which can complicate
  treatment

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Concluding Remarks

• Decreasing stigma remains essential
• Parity in insurance coverage and improved access
  to effective care for poor and underinsured are
  extremely important

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• Planning for transition to adulthood significant
• Social and human costs of non treatment are
  enormous
• Competence and human connections are important
  treatment goals

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• There is great need for more Child and Adolescent
  Psychiatrists (only 7000 in USA for 7.5 million
  seriously affected children)
• Effective treatments are available and lead to
  more productive and satisfying lives for children
  and their families